Patients' Preferences and Willingness-to-Pay for Disease-Modifying Therapies: A Discrete Choice Experiment in the U.S.

Background: While disease-modifying therapies (DMTs) for multiple sclerosis (MS) treatments are costly, patient valuation of DMTs has not been examined. 

Objectives: To examine parents' preferences and willingness-to-pay (WTP) for DMTs. 

Methods: Six attributes (i.e. number of relapses in two years, percentage of disability progression in two years, percentage of severe adverse events, route of administration, frequency of administration, and out-of-pocket cost) and their levels from literature and the interviews of neurologists and patients were used to develop a discrete choice experiment, web-based questionnaire. Each questionnaire was composed of seven choice sets and each choice set contained those six attributes with different levels. A total of 1,200 patients with MS were asked to choose one treatment alternative in each choice set. Multinomial logit model was used to determine relative preferences of each attribute. The WTPs (maximum out-of-pocket amount) for all attributes and DMTs were calculated. 

Results: A total of 508 patients were included in study analyses. On average, the patients were approximately 53 years old and had about 13 years of MS experiences. Intuitively, results showed that the patients preferred DMTs with lower relapse rate, lower disability progression, lower severe adverse event, lower frequency of administration, and lower cost. The patients preferred and were willing to pay more for oral DMTs, compared to other dosage forms. They were willing to pay $2,768, $289, $292, and $76 a month in exchange for every 1-time decrease in the number of relapse in 2 years, every 1% decrease in disability progression in 2 years, every 1 % decrease in severe adverse events, and every 1-time decrease in the frequency of administration per month. While the patients were not willing to pay for interferon beta-1a SC, they were willing to pay for glatiramer acetate 20 mg ($7,021), interferon beta-1a IM ($14,716), interferon beta-1b ($12,670), alemtuzumab ($27,925), daclizumab ($45,975), dimethyl fumarate ($59,997), natalizumab ($64,155), terifunomide ($80,322), fingolimod ($85,741), and pegylated interferon beta-1a ($100,199). 

Conclusions: Patients with MS weighted importance on the route of administration and the number of relapses relatively high, compared to other DMT attributes. Their WTPs for DMTs varied widely and the majority of them were lower than the DMT market prices.